局部巩固性消融治疗改善携带 EGFR 激活突变的初治同步寡转移 NSCLC 患者的生存
Consolidative Local Ablative Therapy Improves the Survival of Patients With Synchronous Oligometastatic NSCLC Harboring EGFR Activating Mutation Treated With First-Line EGFR-TKIs.
机构信息
Department of Radiation Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.
Department of Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.
出版信息
J Thorac Oncol. 2018 Sep;13(9):1383-1392. doi: 10.1016/j.jtho.2018.05.019. Epub 2018 May 29.
INTRODUCTION
The aim of the current study was to investigate whether consolidative local ablative therapy (LAT) can improve the survival of patients with stage IV EGFR-mutant NSCLC who have oligometastatic disease treated with first-line EGFR-tyrosine kinase inhibitor (TKI) therapy.
METHODS
Patients with stage IV EGFR-mutant NSCLC and no more than five metastases within 2 months of diagnosis were identified. All patients were treated with first-line EGFR-TKIs. Consolidative LAT included radiotherapy, surgery, or both. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier curves.
RESULTS
From October 2010 to May 2016, 145 patients were enrolled, including 51 (35.2%) who received consolidative LAT to all oligometastatic sites (all-LAT group), 55 (37.9%) who received consolidative LAT to either primary tumor or oligometastatic sites (part-LAT group), and 39 (26.9%) who did not receive any consolidative LAT (non-LAT group). The median PFS in all-LAT, part-LAT, and non-LAT groups were 20.6, 15.6, and 13.9 months, respectively (p < 0.001). The median OS in all-LAT, part-LAT, and non-LAT groups were 40.9, 34.1, and 30.8 months, respectively (p < 0.001). The difference was statistically significant between the all-LAT group and part-LAT or non-LAT group but was not between the part-LAT and non-LAT group. The median OS was significantly improved with consolidative LAT for primary tumor (40.5 versus 31.5 months, p < 0.001), brain metastases (38.2 versus 29.2 months, p = 0.002), and adrenal metastases (37.1 versus 29.2 months, p = 0.032). Adverse events (grade ≥ 3) due to radiotherapy included pneumonitis (7.7%) and esophagitis (16.9%).
CONCLUSIONS
The current study showed that consolidative LAT to all metastatic sites was a feasible option for patients with EGFR-mutant oligometastatic NSCLC during first-line EGFR-TKI treatment, with significantly improved PFS and OS compared with consolidative LAT to partial sites or observation alone.
简介
本研究旨在探讨对于一线 EGFR 酪氨酸激酶抑制剂（TKI）治疗后发生寡转移的 EGFR 突变型 IV 期非小细胞肺癌（NSCLC）患者，局部根治性治疗（LAT）能否改善其生存。
方法
我们筛选出在诊断后 2 个月内存在不超过 5 个转移灶的 EGFR 突变型 IV 期 NSCLC 患者。所有患者均接受一线 EGFR-TKI 治疗。局部根治性治疗包括放疗、手术或两者结合。采用 Kaplan-Meier 曲线估计总生存期（OS）和无进展生存期（PFS）。
结果
2010 年 10 月至 2016 年 5 月，共纳入 145 例患者，其中 51 例（35.2%）接受所有寡转移灶的局部根治性治疗（全 LAT 组），55 例（37.9%）接受原发灶或寡转移灶的局部根治性治疗（部分 LAT 组），39 例（26.9%）未接受任何局部根治性治疗（非 LAT 组）。全 LAT、部分 LAT 和非 LAT 组的中位 PFS 分别为 20.6、15.6 和 13.9 个月（p<0.001）。全 LAT、部分 LAT 和非 LAT 组的中位 OS 分别为 40.9、34.1 和 30.8 个月（p<0.001）。全 LAT 组与部分 LAT 组或非 LAT 组之间的差异具有统计学意义，但部分 LAT 组与非 LAT 组之间的差异无统计学意义。全 LAT 组的原发灶（40.5 个月 vs. 31.5 个月，p<0.001）、脑转移灶（38.2 个月 vs. 29.2 个月，p=0.002）和肾上腺转移灶（37.1 个月 vs. 29.2 个月，p=0.032）的中位 OS 明显提高。放疗相关的不良事件（≥3 级）包括肺炎（7.7%）和食管炎（16.9%）。
结论
本研究表明，对于一线 EGFR-TKI 治疗后发生寡转移的 EGFR 突变型 NSCLC 患者，对所有转移灶进行局部根治性治疗是一种可行的选择，与对部分病灶进行局部根治性治疗或观察相比，患者的 PFS 和 OS 明显提高。
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